TECHNICAL FIELD
[0001] The present invention relates to a tablet for treating postherpetic neuralgia and
a method of treating postherpetic neuralgia with the use of the tablet.
BACKGROUND ART
[0002] "Pain" includes various kinds ranging from acute pain to chronic pain, such as inflammatory
pain due to inflammation, nociceptive pain caused by cancer and the like, and neuropathic
pain (see Non-Patent Document 1). Among the pains, the neuropathic pain is a generic
term used to refer to pains developed by the damage, compression and the like of nerve
tissues; and is accompanied by severe discomfort and unusual sense such as numbness.
However, the cause of developing neuropathic pain is not well known, and adequate
therapy therefor is not established.
[0003] For example, it is disclosed in Non-Patent Document 1 that methods of treating inflammatory
pain and nociceptive pain have been almost established, while development of therapeutic
agent for chronic pains such as neuropathic pains is just begun. Non-Patent Document
1 was just published in 2006; and it can be thought from the fact that the development
of therapeutic means for neuropathic pain has still not been adequately developed.
[0004] The neuropathic pain include not only postherpetic neuralgia and complex regional
pain syndrome but also phantom limb pain that is felt in amputated limbs, and the
cause is not sufficiently clarified.
[0005] Among neuropathic pain, postherpetic neuralgia is a severe pain developed after treatment
of herpes zoster. The mechanism of developing the severe pain developed after treatment
of herpes zoster is not completely revealed; but, it is said that viruses still remaining
in ganglia even after treatment of herpes zoster are reactivated due to immunological
deterioration or the like, and act directly on nerves to cause postherpetic pain.
Accordingly, postherpetic neuralgia is problematic particularly in the elderly inferior
in immunity. Some data reported that several dozen % of adults remain infected with
herpes zoster virus even after treatment of herpes zoster; therefore, positive treatment
of postherpetic neuralgia becomes important as the population is aging, along with
early treatment of herpes zoster.
[0006] It is said that complete treatment is difficult after transition from herpes zoster
to postherpetic neuralgia. For example, a non-steroidal analgesic agent is first administered
in many cases in actual treatment of postherpetic neuralgia; but, the possibility
of thereby attaining complete responses is very low. Physical methods such as acupuncture
treatment and low-frequency stimulation treatment are used in some cases, but cannot
serve as fundamental therapies. A method of directly alleviating the pain with local
anesthetic agents is sometimes used, but is not effective since the site where the
pain of postherpetic neuralgia develops is often not clear and agents for external
use, such as local anesthetic agent, cannot reach the deep portion of skin.
[0007] It is described in Non-Patent Document 1 that amitriptyline and mexiletine are used
for postherpetic neuralgia. However, the drugs are originally an antidepressant drug
and an antiarrhythmic drug, respectively. Thus, there is no drug specified in treatment
of postherpetic neuralgia under the present circumstances.
[0008] It is described in Non-Patent Documents 2 and 3 that Neurotropin
™, which is an extract from the inflammatory skin of vaccinia virus-inoculated rabbit,
exerts a certain effect on postherpetic neuralgia. However, the inhibitory action
of Neurotropin on postherpetic neuralgia is not significantly different 2 weeks after
administration relative to a placebo group, and becomes significantly different barely
4 weeks after administration, as shown in Non-Patent Document 2. Further, the inhibitory
action of Neurotropin on postherpetic neuralgia does not significantly differ from
that before administration of the drug according to an experiment disclosed in Non-Patent
Document 3.
[0009] In Patent Document 1, is disclosed a method of using devazepide in combination with
an opioid analgesic agent in order to reduce the dose of the opioid analgesic agent.
In the document, is also described a clinical example where devazepide together with
an opioid analgesic agent such as morphine and, if necessary, together with an analgesic
agent such as buprenorphine for sudden pain, was administered by the patient with
neuropathic pain. However, the main objective of the invention described in Patent
Document 1 lies in reducing the dose of an opioid analgesic agent by using devazepide
in combination. In addition, it was only 10 of 41 subjects who attained pain relief
by the invention.
[0010] In Non-Patent Document 4, is described a clinical example wherein an opioid analgesic
agent such as oxycodone hydrochloride or morphine sulfate was intravenously dripped
into the patient with postherpetic neuralgia. In Non-Patent Document 5, is also described
a clinical example wherein oxycodone was intravenously dripped into the patient with
postherpetic neuralgia. In Non-Patent Document 6, is described a clinical example
wherein lidocaine and morphine were intravenously injected into the patient with postherpetic
neuralgia.
[0011] In Patent Document 2, is disclosed a therapeutic agent for neuropathic pain containing
an opioid receptor antagonist as an active ingredient; and buprenorphine is exemplified
as the opioid receptor antagonist and postherpetic neuralgia is exemplified as neuropathic
pain. However, there is no description of a specific example wherein buprenorphine
was administered to the patient with postherpetic neuralgia therein.
[0012] Buprenorphine has been used as an analgesic agent and already marketed as an injection,
a suppository and a sublingual tablet. However, the buprenorphine level in blood is
rapidly increased and immediately decreased when the preparations are administered;
and thus, the effect by the preparations is transient. Accordingly, regarding the
preparations, highly frequent administration is necessary against chronic pain and
may cause the problem of side effects. In sublingual tablets, there is also a problem
of the poor absorption efficiency of buprenorphine itself. There is also an example
where buprenorphine was used as a drug for external use; but the preparation is not
practical since buprenorphine is extremely poor in percutaneous absorption.
[0013] The researcher belonging in the present applicant developed an oral mucosa-adhering
buprenorphine preparation used mainly in treatment of cancer pain, and had a patent
application on the preparation. The preparation is disclosed in Patent Document 3.
However, the cancer pain is a nociceptive pain that is caused due to compression of
an organ by growth of cancer cells, metastasis of cancer cell to bone, or a side effect
of an anticancer agent; and the cause of thereof is completely different from that
of neuropathic pain such as postherpetic neuralgia. Actually, major uses of a buprenorphine
injection and suppository manufactured and marketed in Japan lie in relieving postsurgical
pain, or pain attributable to cancer or myocardial infarction as well as in assisting
anesthesia.
Non-Patent Document 1: Katsuo Toide, Journal of the Japanese Pharmacological Society, Vol.128, pp.321-325
(2006)
Non-Patent Document 2: Hideo Yamamura, et al. "Igaku No Ayumi" (Development of Medicine), Vol.147, No.7,
pp.651-664 (1988)
Non-Patent Document 3: Michio Hashikabe, et al., Nishi Nichi Hifu (The Nishinihon Journal of Dermatology),
Vo.65, No.1, pp.65-69 (2003)
Patent Document 1: Published Japanese translation of PCT international publication
for patent application No.2005-533046
Non-Patent Document 4: Robert H. Dworkin et al., Archives of Neurology, Vol.60, pp.1524-1534 (2003)
Non-Patent Document 5: C. Peter N. Watson et al., American Academy of Neurology, Vol.50, pp.1837-1841 (1998)
Non-Patent Document 6: Michael C. Rowbotham et al., Neurology, Vol.41, pp.1024-1028 (1991)
Patent Document 2: Japanese Patent Publication No.2006-131545A
Patent Document 3: Japanese Patent Publication No.8-291070A
DISCLOSURE OF THE INVENTION
[0014] As described above, postherpetic neuralgia becomes particularly problematic for the
arrival of an aging society; however, there is still no effective therapeutic means
therefor.
[0015] The objective of the present invention is to provide a practical therapeutic agent
for postherpetic neuralgia and a method of treating postherpetic neuralgia.
[0016] The inventors searched for a drug capable of effectively treating postherpetic neuralgia.
As a result, the inventors found that buprenorphine hydrochloride exhibits an extremely
excellent therapeutic effect on postherpetic neuralgia when administered sustainably
via oral mucosa, not through experiments on animals or the like, but through actual
clinical tests; and the present invention was thereby completed.
[0017] The therapeutic tablet for postherpetic neuralgia according to the present invention
is characterized in comprising buprenorphine hydrochloride, having a double layer
structure consisting of a quick-release layer and a sustained-release layer, wherein
the tablet is adhesive to the oral mucosa.
[0018] The method of treating postherpetic neuralgia according to the present invention
is characterized in comprising a step of applying the above therapeutic tablet for
postherpetic neuralgia according to the present invention on the oral mucosa of a
patient.
BRIEF DESCRIPTION OF THE DRAWINGS
[0019]
FIG. 1 is a graph showing "pain VAS values" in case that a buprenorphine hydrochloride
preparation was administered to the patient with complex regional pain syndrome.
FIG. 2 is a graph showing "pain VAS values" in case that a buprenorphine hydrochloride
preparation was administered to the patient with postherpetic neuralgia.
FIG. 3 is a graph showing "pain degree (VRS)" in case that a buprenorphine hydrochloride
preparation was administered to the patient with complex regional pain syndrome.
FIG. 4 is a graph showing "pain degree (VRS)" in case that a buprenorphine hydrochloride
preparation was administered to the patient with postherpetic neuralgia.
BEST MODE FOR CARRYING OUT THE INVENTION
[0020] The therapeutic tablet for postherpetic neuralgia according to the present invention
is characterized in comprising buprenorphine hydrochloride, having a double layer
structure consisting of a quick-release layer and a sustained-release layer, wherein
the tablet is adhesive to the oral mucosa.
[0021] The therapeutic objective of the tablet according to the present invention is postherpetic
neuralgia. The cause of postherpetic neuralgia is not necessarily evident; however,
postherpetic neuralgia is considered attributable to the virus which remains in ganglia
even after treatment of herpes zoster and is reactivated due to reduction in immunity
or the like and acts directly on nerves. Therefore, severe pain may persist for a
long period, particularly in immune-compromised aged persons and sick persons. At
the same time, the pain is very difficult to be reduced since the reactivated herpes
zoster virus acts directly on nerves. Postherpetic neuralgia, which is hardly treatable
by the prior art as described above, can be effectively cured with the therapeutic
agent of the present invention.
[0022] The chemical name of buprenorphine hydrochloride is N-cyclopropylmethyl-7α-(S-1-hydroxy-1,2,2-trimethylpropyl)-6,1
4-endo-ethano-6,7,8,14-tetrahydronororipavine hydrochloride. Buprenorphine hydrochloride
is used mainly as a nonnarcotic analgesic; and more specifically, is used in relieving
pain after surgery or attributable to cancer and in assisting anesthesia.
[0023] Buprenorphine hydrochloride is preferably added in the tablet of the present invention
in an amount of 0.1 mg or more per tablet. According to the inventors' finding, the
inhibitory effect of the tablet on pain is increased with an increasing amount of
buprenorphine hydrochloride per tablet. Even a tablet containing 0.1 mg of buprenorphine
hydrochloride has an inhibitory effect on pain; but the effect is improved in a dose-dependent
manner, and a tablet containing 0.3 mg of buprenorphine hydrochloride has a sufficient
effect as shown in the later described Examples. At the same time, as the amount of
buprenorphine hydrochloride per tablet increases, there is an increasing danger of
adverse events such as side effects. Hence, the amount of buprenorphine hydrochloride
per tablet is preferably 1.0 mg or less, more preferably 0.8 mg or less.
[0024] The tablet of the present invention has a double layer structure consisting of a
quick-release layer and a sustained-release layer, and is used by being applied on
the oral mucosa. Conventionally, buprenorphine hydrochloride preparations have been
developed mainly as an injection or a suppository. In the present invention, however,
buprenorphine is absorbed via the oral mucosa, thereby effectively suppressing postherpetic
neuralgia. The tablet of the present invention has a double layer structure consisting
of a quick-release layer and a sustained-release layer, thereby attaining both quick
effect and sustained release.
[0025] The reason why postherpetic neuralgia is effectively suppressed by using such administration
form is not necessarily evident. However, it can be estimated that, for example, the
oral mucosa-adhering preparation having such a double layer structure does not cause
rapid increase of the buprenorphine level in blood as compared with an injection and
thus is less danger of side effects as well as excellent in durability of drug action.
Although the site where the pain is felt cannot be accurately grasped in postherpetic
neuralgia, buprenorphine absorbed moderately via the oral mucosa is likely of persistently
stabilizing patients' feel, thereby making the patient forget the pain.
[0026] The tablet of the present invention can be produced by a conventional method. For
example, the quick-release layer should be relatively rapidly disintegrated to release
buprenorphine hydrochloride; therefore, relatively large amounts of a component used
as excipients and disintegrators such as mannitol and talc is added in the layer.
[0027] It is preferable to add not only buprenorphine hydrochloride but also polyvinylpyrrolidone
or a pharmaceutically acceptable salt thereof, polyacrylic acid or a pharmaceutically
acceptable salt thereof, and sodium bicarbonate in the sustained-release layer of
the tablet according to the present invention.
[0028] A sustained-release property is given to the sustained-release layer in the tablet
of the present invention by adding both of polyvinylpyrrolidone or a pharmaceutically
acceptable salt thereof and polyacrylic acid or a pharmaceutically acceptable salt
therein. Specifically, polyvinylpyrrolidone having binding property and polyacrylic
acid having adhesive property are allowed to be coexistent, so that suitable sustained-release
property can be given to the sustained-release layer. Though the ratio of the two
components may be appropriately regulated, the ratio of the polyvinylpyrrolidone or
pharmaceutically acceptable salt thereof relative to the total of the polyvinylpyrrolidone
or pharmaceutically acceptable salt thereof and the polyacrylic acid or pharmaceutically
acceptable salt is preferably 5% by mass or more and 95% by mass or less. When the
ratio is lower than 5% by mass, the expansibility of the tablet is so strong that
foreign-body sensation may be caused upon application to the oral cavity. On the other
hand, when the ratio is higher than 95% by mass, the adhesiveness of the tablet may
be decreased.
[0029] It is preferable to add sodium bicarbonate in the sustained-release layer of the
tablet according to the present invention. Buprenorphine hydrochloride as the active
ingredient of the tablet according to the present invention is an acidic drug, and
the swelling ability of polyacrylic acid may be deteriorated under acidic conditions.
Therefore, a pH regulator, preferably sodium bicarbonate, is added to neutralize the
sustained-release layer. The amount ratio of sodium bicarbonate added into the sustained-release
layer is preferably 7.0% by mass or more and 7.5% by mass or less relative to the
polyacrylic acid or pharmaceutically acceptable salt thereof. When the ratio is 7.0%
by mass or more, the swelling ability of polyacrylic acid can be sufficiently secured,
thereby more reliably releasing buprenorphine hydrochloride. On the other hand, when
the ratio is higher than 7.5% by mass, a carboxy vinyl polymer is swollen so significantly
that buprenorphine hydrochloride may be possibly released too quickly.
[0030] Examples of pharmaceutically acceptable salts of polyvinylpyrrolidone and polyacrylic
acid include alkali metal salts such as sodium salt and potassium salt, alkaline earth
metal salts such as calcium salt and magnesium salt, and ammonium salts.
[0031] It is possible to further add known compounding ingredients such as a lubricant,
a binder, a flavoring substance and a coloring agent in the tablet of the present
invention.
[0032] The tablet of the present invention can be produced, for example, by feeding ingredients
for the quick-release layer and the sustained-release layer to a tableting machine
capable of producing a double-layer tablet, and tableting the ingredients into double-layer
tablets.
[0033] The method of treating postherpetic neuralgia according to the present invention
is characterized in comprising a step of applying the above therapeutic tablet for
postherpetic neuralgia according to the present invention on the oral mucosa of a
patient. The dose of the tablet of the present invention may be controlled appropriately
depending on, for example, the severity, age and sex of a patient; for example, one
tablet may be applied once or twice per day on the gingival area.
EXAMPLES
[0034] Hereinafter, the present invention is described in more detail with reference to
the Examples; but the present invention is not limited to the Examples and can be
carried out in such a range as to be adapted to the purport of the description in
the specification; and any of such modifications are included in the scope of the
present invention.
Production Example 1: Production of an oral mucosa-adhering buprenorphine preparation
[0035] Buprenorphine hydrochloride (2.156 g), polyvinylpyrrolidone (27.4 g) and Edible Blue
No. 1 (0.03 g) were dissolved in purified water (431.2 g). The resulting solution
was sprayed onto D-mannitol (723.0 g) in a fluidized-bed granulating machine using
purified water (50 g) as a rinse, and then dried, thereby preparing granules. The
granules (100 parts by mass) were mixed with magnesium stearate (1 part by mass) and
talc (0.56 part by mass), to prepare quick-release layer granules.
[0036] Separately, buprenorphine hydrochloride (4.312 g) and polyvinylpyrrolidone (8.624
g) were dissolved in purified water (862.4 g). The resulting solution was sprayed
onto polyvinylpyrrolidone (844.9 g) in a fluidized-bed granulating machine using purified
water (50 g) as a rinse, and then dried, thereby preparing granules. The granules
(100 parts by mass) were mixed with polyacrylic acid (19.3 parts by mass) and sodium
bicarbonate (1.42 parts by mass). The resulting mixture was compressed with a roller
compactor. The compressed product was broken to pieces. Particle size regulation was
carried out by using with a power mill; further, the particles were sieved with a
sieve having 500-µm openings, to prepare sustained-release layer granules. The ratio
of polyvinylpyrrolidone relative to the total of polyvinylpyrrolidone and polyacrylic
acid in the sustained-release layer was about 83.8% by mass, and the ratio of sodium
bicarbonate relative to polyacrylic acid in the sustained-release layer was about
7.4% by mass.
[0037] The quick-release layer granules and the sustained-release layer granules were charged
into a tableting machine and formed into oral mucosa-adhering double-layer tablet
each containing buprenorphine hydrochloride in amounts of 0.1 mg and 0.2 mg in the
quick-release layer and sustained-release layer, respectively. Separately, buprenorphine
hydrochloride was used in half or twice amount in the protocol described above, so
oral mucosa-adhering double-layer tablet each containing buprenorphine hydrochloride
in amounts of 0.05 mg and 0.1 mg in the quick-release layer and sustained-release
layer respectively, or each containing buprenorphine hydrochloride in amounts of 0.2
mg and 0.4 mg in the quick-release layer and sustained-release layer respectively,
were produced. Hereinafter, the buprenorphine hydrochloride tablets are referred to
as 0.3 mg tablet, 0.15 mg tablet and 0.6 mg tablet, respectively. In addition, placebo
tablet that did not contain buprenorphine hydrochloride but had the same appearance
as that of the buprenorphine hydrochloride tablets were produced.
Test Example 1
(1) Double-Blind Comparative Test
[0038] First, a double-blind comparative test (hereinafter, referred to as "DB test") was
carried out. The subjects in the test were specifically patients with postherpetic
neuralgia and patients with complex regional pain syndrome, who were 20- to 74-year-old
Asians out of patients with non-cancerous chronic pain and from whom the consent for
the test was beforehand obtained. The pain therapy previously conducted up to 4 days
before initiation of the test was continued, and the test was carried out in addition
to the pain therapy. However, it was prohibited to add new pain therapy other than
the therapy in the experiment and to change the condition of the previous pain therapy.
The 126 subjects were divided at random into a group including 33 subjects given the
placebo tablet , a group including 30 subjects given the 0.15 mg tablet, a group including
31 subjects given the 0.3 mg tablet and a group including 32 subjects given the 0.6
mg tablet.
[0039] First, the subjects were observed for 1 to 4 days without being administered with
the tablets. The period is referred as "Former observation period". Then, the subjects
were administered with the tablet for 7 days from the fifth day. The period is referred
as "Administration period". In the administration period, the subjects were not informed
of the dose. The administration was carried out once per day by inserting each tablet
into the space between the upper lip and the upper gingival and then applying the
sustained-release layer on the upper gingival. During the former observation period
and the administration period, the intensity of pain, i.e. pain VAS value, was indicated
at each point of time by the subjects with 100 mm as "maximum pain" and 0 mm as "no
pain". At each point of time, the degree of pain, i.e. VRS, was evaluated by the subjects
in 4 grades, that is, 0: no pain, 1: light, 2: moderate and 3: severe. During the
test period, sleep, appetite, mood and pleasure were evaluated respectively in 4 grades
from 0 to 3 by each subject, thereby determining "the degree of satisfaction of daily
life".
[0040] During the test, 13 of 126 cases could not be evaluated for reasons such as failure
to comply with provisions of the protocol. In the 113 cases that could be evaluated,
the pain was hardly improved in the group given the placebo tablet, while the other
groups were observed to get the effect to relieve pain in accordance with the dose
of buprenorphine hydrochloride.
(2) Continuous Administration Test
[0041] Out of the patients having completed the DB test, the patients for whom a principal
investigator had judged the continuous administration to be beneficial and who had
desired continuous administration were further subjected to a continuous administration
test from 1 day after the DB test. The subjects who could be evaluated were made up
of 20 patients with postherpetic neuralgia and 23 patients with complex regional pain
syndrome.
[0042] The tablets containing buprenorphine hydrochloride in amounts of 0.3 mg and 0. 6
mg respectively, which were prepared in Production Example 1, were administered to
the subjects in the same manner as described above in the DB test. Hereinafter, the
tablets were referred to as "0.3 mg tablet" and "0.6 mg tablet". First, the 0.3 mg
tablet was administered once per day to each patient. Then, the tablet was changed
if necessary to the 0.6 mg tablet while the analgesic effect and safety were confirmed,
so that the analgesic effect could persist for 24 hours. When the 0.6 mg tablet did
not maintain the analgesic effect for 24 hours or when the 0.6 mg tablet should be
changed to the 0.3 mg tablet for reasons such as adverse events, the tablet was administered
twice per day, that is, at 12-hour intervals.
[0043] During the administration period, pain VAS value and pain degree, i.e. VRS, were
evaluated by each subject in the same manner as in the DB test. The result of pain
VAS value in the patients with complex regional pain syndrome is shown in Fig. 1,
and the result of pain VAS value in the patients with postherpetic neuralgia is shown
in Fig. 2. In Figs. 1 and 2, "Administration starting date in DB test" shows the result
on the day when the administration of the tablet in the DB test was started, "Observation
period after DB test" shows the result for 1 day after the DB test and before the
continuous administration test, "In X week in the administration period" shows the
result in X week from the start of administration of the buprenorphine hydrochloride
tablet in the continuous administration test, and "Observation period after continuous
administration test" shows the result on the day after the administration of the buprenorphine
hydrochloride tablet over 24 weeks was finished.
[0044] As shown in Fig. 1, the VAS value was decreased from 67.0 ± 21.6 in the observation
period after the DB test to 61.1 ± 23.9 in the observation period after the continuous
administration test. The result was verified by Wilcoxon 1 sample test; as a result,
there was a significant pain relief effect with p < 0.05 (p = 0.037). However, it
can be seen from Fig. 1 that the VAS value does not change so much as a whole in case
that the buprenorphine hydrochloride tablets were administered to the patients with
complex regional pain syndrome.
[0045] On the other hand, it is shown in Fig. 2 that the VAS value was continuously decreased
after start of the administration, so that the average VAS value that was nearly 70
on the starting date of administration was changed to remain stably in the 40s during
the administration period, in case that the buprenorphine tablet was administered
to the patients with postherpetic neuralgia. In other words, the patients with postherpetic
neuralgia given the buprenorphine hydrochloride tablet felt that the pain was decreased
to a degree less than the medium degree. The significant difference in the patients
with postherpetic neuralgia in the observation period after the continuous administration
test relative to the observation period after the DB test was verified by Wilcoxon
1 sample assay; as a result, the VAS value was decreased from 60.5 ± 21.8 to 51.3
± 26.2, and there was a significant pain relief effect with p < 0.05 (p = 0.031).
[0046] When the buprenorphine hydrochloride tablet was administered to the patients with
complex regional pain syndrome, many of the patients answered "they can have a sound
sleep" and the improvement could be shown. However, the other item "the degree of
satisfaction of daily life" was not found to significantly change as a whole. As shown
in Fig. 3, there was no improvement in "pain degree (VRS)".
[0047] On the other hand, as shown in Fig. 4, sthe ratio of "1: light" in pain degree (VRS)
was high during the administration period and thus the clear improvement could be
shown, in a case the buprenorphine hydrochloride tablet was administered to the patients
with postherpetic neuralgia. With respect to "the degree of satisfaction of daily
life" in the patients with postherpetic neuralgia, a high proportion of the patients
given the buprenorphine hydrochloride tablet answered "they can have a sound sleep",
"feel very well", "feel well" and "are very enjoyable", and thus clear improvement
tendency could be shown.
[0048] As shown in the results, it was demonstrated that the pharmaceutical preparation
containing buprenorphine hydrochloride has an extremely excellent therapeutic effect
on particularly postherpetic neuralgia among neuropathic pains.
INDUSTRIAL APPLICABILITY
[0049] The therapeutic tablet for postherpetic neuralgia according to the present invention
can very effectively cure postherpetic neuralgia for which there has been no truly
effective therapeutic means. Accordingly, the tablet of the present invention is extremely
industrially useful as a therapeutic agent for postherpetic neuralgia from which particularly
the elderly suffers over a long period.